Overcoming the Doctor-Patient War of Words

I seem to have hit a nerve with my post about Dr. Steve Cole’s editorial published a few days ago. Dr. Cole asserted that the reason healthcare costs are going up is because doctors have learned to milk the system in ways related to how they order tests, prescribe meds and other tasks which allow them to use billing codes that get reimbursed by insurance at a higher rate.

Wow! Here are a few of the post outcomes:

My blog hits doubled.

The number of comments to the post doubled over my highest day previously.

Several doctors — those who commented and those who emailed — were ready to shoot the messengers — both Dr. Cole and me!

Some doctors agreed with Dr. Cole.

Some doctors vehemently disagreed.

And patients — always the ones who find themselves at the bottom of the totem pole, once again feel victimized by the whole sorry situation, regardless of how it came about or how it’s being handled.

As your friendly — and peace loving — Every Patient’s Advocate — let me raise a few points and clarifications:

There are many reasons the costs of healthcare are increasing. Dr. Cole offered one set of reasons but certainly not all of them. Others include the wish for private insurance to profit more and more, the too-high costs of drugs, the bad habits of patients which require more care to “fix” them (like smoking, obesity and others), the increasing healthcare costs of an aging baby boomer population, the fact that people are living longer, meaning they need higher priced care longer, the higher costs of advanced technology, and others. One commenter to the blog (justordinaryjoe) took a stab at this master list and did a good job at it.

What truly upsets me — UPSETS ME — is that somehow this translates to a them-vs-us discussion. Doctors VERSUS patients or patients VERSUS doctors. We’ve lost the “and” — and that, to me, is frightening and dangerous. This is not about a conflict. But it is about a loss of trust.

But a patient’s loss of trust in his/her doctor is not the trust that should be lost. The patient AND the doctor should be focusing their lack of trust on the very system that has created it. That’s what is broken — the system of healthcare in America. And it won’t be doctors or patients who can fix it, even though it’s doctors and patients who pay the highest price.

Recognizing that it’s the system — and not the doctors and patients — then we patients must work harder to collaborate with our doctors, and doctors must work harder to collaborate — and respect — patients. Here are some of the ways that can happen:

1. Respect for TIME: Time is money. And the respect for time is one of the biggest violations.

Doctors — PLEASE respect the time of your patients. Give them your 100 percent attention during those brief six or eight minutes you will see them. And don’t make them wait in waiting rooms for more than 10 minutes. After 10 minutes, it is a violation of your patient’s time.

And patients — PLEASE respect your doctor’s time. He can’t make a living (and yes, I’m serious about that) if you impose on his time for more than you deserve. Granted, you are hiring him to do a job for you. But you aren’t paying him out of your pocket — and you just can’t have ALL the time you want — so be concise, be specific, ask targeted questions and move on.

2. Respect for KNOWLEDGE

Doctors — you don’t have a corner on all the knowledge. Please respect that patients know their own bodies better than you do. Don’t try to fit their square problems into your round holes. Understand that the internet does yield ideas for them and be willing to discuss them, even if they seem ludicrous to you.

Patients — your doctor spent up to 12 years gaining the medical education needed to accurately diagnose and treat you. Don’t think that by spending an hour or two on the internet, or by talking to other people, that you can trump that education. Ask for help in translating new information you learn… and do so with….3. Respect for the COLLABORATIVE PROCESS: Getting to WELL is not one sided.Doctors — please don’t jump to conclusions. Doctors must work WITH their patients — not AT them. And never EVER (well, OK, hardly ever) tell any patient that a malady is all in her head! (see RESPECT below.)

And Patients — make sure you participate collaboratively, too. Ask questions that allow you to assess possibilities, ask more questions, and arrive at a decision WITH your doctor, not just because your doctor tells you that it’s the “best” answer for you. YOU are the only person who can determine the best answer for you.

4. Respect for DECISION-MAKING

Patients — YOU are the people with the responsibility for making decisions about your own bodies (and, in terms of advanced directives, your own demise.) You need to step up to that plate to do so. Don’t just default to what the doctor recommends. Ask instead for a good review of ALL your treatment options, the pros and cons of each, and then make as objective a decision possible based on that input.

Doctors — don’t abbreviate the list of options you give a patient just because you think others aren’t good options. (And a message to many — don’t try to tell me that doesn’t happen, because even if you don’t do it, you know it happens with your colleagues.)

5. Respect for…. RESPECT

Doctors — working with a patient does not allow you to judge him or her. I wish I had a nickel for every time a patient has said, “The doctor just laughed at me.” or “I was so insulted!” A patient comes to you for help and counsel — not for your judgment. You need to treat that patient respectfully.

Patients — and I’m serious about this — the only time you need to respect your doctor is if that doctor deserves respect. If your doctor laughs at you or insults you, or in some way makes you feel like less than the respect-deserving person you are — say something! And if you can’t muster the ability to say something, then send them a report card and tell them. And — if necessary — find yourself another doctor.

And the bottom line is:Doctors: please make sure your patients understand and experience the respect they deserve. For most of you, this is a daily occurrence. But we all know that for many, it’s not even on their radar.

Patients: stop expecting your doctors to be gods who can overcome a broken system to help you get the medical attention you need. For most doctors are truly doing the best they can. And it’s up to you to weed out the ones who aren’t — and walk away.

Like this:

Thank you for such a wonderful article! Respect is needed by both doctors and patients! Working together is going to create the most optimum atmosphere.

Dr Steven Cole on January 2, 2008 at 5:59 pm

Most of the push-back I have received regarding the article I have written has come from individuals that are focusing on a few sentences and not the entire article. I agree with many of the comments made in this discussion forum, especially the ones relating to the fact that doctors are absolutely not the only ones to blame. In fact, I referenced this in the opening statement of the article. The truth is, there are TONS of factors involved in the rising cost of healthcare, but I just wanted to point out that physicians are in a good position to curb that cost. I applaud Trisha’s efforts to try to put things in perspective. Let’s not all get too caught up in examining the tree when there’s a much more interesting forrest out there that deserves our attention.

Maggie on January 17, 2008 at 6:44 pm

Statement #1 says to respect the doctor in respect of his time because “you aren’t paying him out of your pocket.” Is the doctor working for free? I pay my doctor. I have a $2million dollor lifetime ceiling on my health insurance . I pay co-payments and yearly deductables. Every year all health payments that don’t come out of my pocket are deducted from my rapidly decreasing original amount of $2million. At the age of 57, I could have one or more catastrophic illiness’ that would total more than the balance of my insurance account. Why do people always think in terms of their medical bills as the cost of co-payments and the balance after insurance makes a payment. If the bill was $275, you paid $275, not $20 co-pay. You also paid whatever you might pay per month if you are not lucky enough to have an employer that pays for your insurance. Get realistic. When my doctor order a $210 urinalysis (twice), I realized it was time I stopped looking at codes and started asking what the code was a test for or what it meant. I’m in favor of stopping codes on my billing so that I can know when I’ve been charged for something I didn’t receive. The insurance company said to call them as often as I want to find out what the code means, and I will. If everyone does it, they may get sick of answering questions and overbilling might stop.

You make a point, Maggie. I see where you are coming from on the payment side.

My reference was to the fact that (except for copays) you are not the direct payer — the insurance company is. And here’s the problem as far as the doctor is concerned: he might charge $100 for a visit — but his reimbursement for that visit is a fraction — a FRACTION of what he charges. (I heard from a doctor this week that she gets reimbursed $17 for doing a Medicaid physical that takes up to an hour. That just seems ridiculous to me!)

In your example, if the bill is $275, depending on what comprised that $275, the doctor gets the $20 copay from you, then maybe $150 from the insurance company or Medicare. So unless you are paying cash for the visit, he’s down $100 from what he charges. Can you think of any other profession that charges one thing, only to be told what will be paid instead?

Regarding codes — I agree that bills need to be in English — but I think both need to be listed on the billing. There are different levels of different services, for example. And you don’t want to read “physical” and be charged $500, when you might have only touched your toes and had your blood pressure taken, a “physical” code that is much less.

Your post points out one of the HUGE problems in healthcare; that is, we patients, being so far adrift from the payment systems, don’t really have a handle on how it is paid for. That leads to way too many contributions to a system that is already so highly dysfunctional that people die from it every day.